Why Cyclists get Low Back Pain and how to fix it

Cycling is rapidly gaining popularity in Australia, with more people riding for physical fitness, transportation, and environmental reasons. I was fortunate to be able to work a season in Girona with professional cycling and triathlon. During this time working alongside highly respected physiotherapists in the sport, and doing a lot of reading and learning, I was able to deepen my understanding of the demands of cycling and triathlon. This enhanced my skills to manage the needs of athletes, optimising their recovery and helping them return to performance following multiple different injuries. In this series of blogs related to cycling injuries, I hope to share some of my learnings and expertise on how physio can help manage cycling injuries.

Low back pain being one of the most common injuries experienced by cyclist. 27% of amateur cyclists, and 58% of elite cyclists report low back pain in the past year.

What causes low back pain in cycling?

Low back pain in cycling is likely multifactorial, involving a range of potential internal and/or external factors such as:

External factors

• Increase in climbing volume
• Increase in hours on the bike
• Increase in big gear efforts such as with low cadence strength sessions
• Inadequate bike set up
• A sudden change to bike set up / riding equipment

Internal factors

• Prolonged flexed lumbar position assumed while riding
• Reduced trunk muscle motor control and endurance
• Reduced hip muscle strength and stability
• Muscle flexibility limitations

What to do if I am experiencing low back pain while cycling?

A physiotherapy assessment is recommended to identify the underlying causes of low back pain, and guide effective management strategies. This process typically involves a comprehensive assessment, beginning with a detailed subjective assessment that includes the cyclist’s history, current training load, and goals. Following this, a thorough objective assessment will be conducted, which may include an assessment of:

• Joint mobility
• Muscle flexibility
• Single leg stability
• Strength
• Trunk muscle endurance

How is low back pain typically managed in cyclists?

1. Cycling training load management: This may involve temporary alterations to training load, terrain or equipment so we can keep you riding throughout rehabilitation!
2. Trunk muscle exercise rehabilitation: Cyclists with a history of low back pain may have higher activation of larger back muscles compared to cyclists without a history of low back pain (Sampieri et al., 2024). This may be an inefficient muscle recruitment strategy. However, it is unknown whether this may be causative or a result of having low back pain. It is hypothesised that altered back muscle function may increase risk of further episodes of low back pain.
3. Spinal mobility exercises including the lumbar and/or thoracic spine
4. Stretching muscle groups such as the hip flexors, quadriceps, hamstrings and gluteal muscles
5. Muscle strengthening including the deeper hip stabilisers, gluteus maximus, hamstrings, quadriceps and soleus
6. Pedalling technique advice
7. Bike fit: A properly fitted bike can help reduce stress on your back, and something you should consider. Your physiotherapist can help recommend where your bike fit can be optimised

• Written by Josie Pepper

  Josie Pepper is a physiotherapist with a Bachelor of Physiotherapy from Newcastle University and extensive experience in musculoskeletal care. She has a special interest in cycling, triathlon, and foot and ankle injuries and is currently completing a Master of Sports Physiotherapy at La Trobe University. A trained Clinical Pilates instructor with expertise in strength and conditioning, Josie is dedicated to helping patients achieve their rehabilitation goals through tailored exercise programs. Outside of work, she is a competitive road cyclist, riding for a Melbourne-based team.